GP Network Plan – 2020 Comparisons
GP Network Plan: Are generally designed for younger people entering the medical aid market for the first time or for those clients that have a limited medical aid budget.
The Medical Aid companies generally contract with a group of hospitals and GP’s on a capitation* basis and in this way are able to offer medical cover at more affordable rates.
*Capitation means that a member will be able to visit his/her chosen GP without having to pay for the consultation. The Medical Aid agrees to pay a monthly amount to the GP, regardless of how often the member visits that GP.
GP Network Plan Members generally need to work through their GP (the Gatekeeper), regardless of the particular ailment.
With spiraling medical aid inflation, the Network Plans have become far more popular in the last few years.
View our latest 2020 plan updates below.
GP Network Plans2020 Comparisons Made Easy!
| DISCOVERY | |||
| KEYCARE PLUS - Network Plan | |||
| MONTHLY CONTRIBUTIONS | |||
| Income p/m | R0-R8,550 | R8,551-R13,800 | R13,800 + |
| Principal Member | R 1,207 | R 1,659 | R 2,450 |
| Spouse/Adult Dependant | R 1,207 | R 1,659 | R 2,450 |
| Per Child (Max 3) | R 439 | R 468 | R 656 |
| IN HOSPITAL BENEFIT | |||
| 2020 BENEFITS | |||
| 100% Scheme Rate | |||
| No Overall Annual Limit | |||
| Full Cover Network Hospitals to be used. | |||
| Certain procedure only covered at Network Day Clinics. | |||
| Annual Sub-limits per person: | |||
| Psychiatric Treatment | 21 days | ||
| Hospice Care | R 48,200 | ||
| Oncology | PMB | ||
| CHRONIC MEDICATION | |||
| 100% Scheme Rate | |||
| 27 PMB Chronic Disease Conditions. | |||
| Subject to scheme formulary. | |||
| Only from a Network Pharmacy or chosen GP. | |||
| ANNUAL DAY TO DAY BENEFIT | |||
| (including Savings) | |||
| 100% Scheme Rate | |||
| GP's | No Limit from KeyCare Network Providers. | ||
| (4 out-of-network visits) | |||
| Specialists: | R 4 400 per person from Network Providers. | ||
| (must be referred by Network GP) | |||
| Conservative Dentistry: | No Limit from KeyCare Network Providers. | ||
| ANNUAL THRESHOLD | |||
| Does not apply | |||
| DISCOVERY | |||
| KEYCARE START - Network Plan | |||
| MONTHLY CONTRIBUTIONS | |||
| Income p/m | R0-R9,150 | R9,151-R13,800 | R13,801+ |
| Principal Member | R 914 | R 1,538 | R 2,394 |
| Spouse/Adult Dependant | R 914 | R 1,538 | R 2,394 |
| Per Child (Max 3) | R 550 | R 601 | R 650 |
| IN HOSPITAL BENEFIT | |||
| 2020 BENEFITS | |||
| 100% Scheme Rate | |||
| No Overall Annual Limit | |||
| Full Cover Network Hospitals to be used. | |||
| Certain procedure only covered at Network Day Clinics. | |||
| Annual Sub-limits per person: | |||
| Psychiatric Treatment | 21 days | ||
| Hospice Care | R 48,200 | ||
| Oncology | PMB | ||
| CHRONIC MEDICATION | |||
| 100% Scheme Rate | |||
| 27 PMB Chronic Disease Conditions. | |||
| Subject to scheme formulary. | |||
| Only from a State Hospital | |||
| ANNUAL DAY TO DAY BENEFIT | |||
| (including Savings) | |||
| 100% Scheme Rate | |||
| GP's | No Limit from KeyCare Network Providers. | ||
| (2 out-of-network visits) | |||
| Specialists: | R 2 200 per person from Network Providers. | ||
| (must be referred by Network GP) | |||
| Conservative Dentistry: | No Limit from KeyCare Network Providers. | ||
| ANNUAL THRESHOLD | |||
| Does not apply | |||
| FEDHEALTH | |||||
| MYFED - Network Plan | |||||
| MONTHLY CONTRIBUTIONS | |||||
| Income p/m | R1-R6,251 | R6,252-R10,219 | R10,220-R12,622 | R12,623-R14,426 | R14,427+ |
| Principal Member | R 1,023 | R 1,297 | R 1,818 | R 2,310 | R 3,133 |
| Spouse/Adult Dependant | R 893 | R 1,126 | R 1,587 | R 1,904 | R 2,854 |
| Per Child (Max 3) | R 492 | R 634 | R 697 | R 903 | R 1,194 |
| IN HOSPITAL BENEFIT | |||||
| 2020 BENEFITS | |||||
| 100% Scheme Rate | |||||
| No Overall Annual Limit | |||||
| Network Hospitals to be used. | |||||
| R12 000 co-payment on voluntary | |||||
| non-network admissions. | |||||
| *7 days Take Home Medicine | |||||
| *Emergency Trauma at Out Patients | |||||
| Psychiatric Treatment | R 9,100 | ||||
| Hospice Care | n/a | ||||
| Oncology | PMB | ||||
| Internal Prosthesis | PMB | ||||
| CHRONIC MEDICATION | |||||
| 100% Scheme Rate | |||||
| 27 Chronic Disease Conditions. | |||||
| Subject to Basic Scheme formulary. | |||||
| Only from Medi-Rite, Clicks, Dis-Chem & | |||||
| Pharmacy Direct. | |||||
| ANNUAL DAY TO DAY BENEFIT | |||||
| (including Savings) | |||||
| 100% Scheme Rate | |||||
| GP's | No Limit from Network Providers. | ||||
| (2 out-of-network visits) | |||||
| Specialists: | 2 visits limited to R 1 800 per person from Network Providers. | ||||
| (must be referred by Network GP) | |||||
| Conservative Dentistry: | Only from a Network Provider. | ||||
| (Fillings, extractions, consultations) | |||||
| Plastic dentures limited to one set per person every 2 years. | |||||
| ANNUAL THRESHOLD | |||||
| Does not apply | |||||
| MOMENTUM INGWE OPTION | |||||
| INGWE NETWORK HOSPITALS - Network Plan | |||||
| MONTHLY CONTRIBUTIONS | |||||
| Income p/m | R0-R725 | R726-R7,150 | R7,151-R9,450 | R9,451-R13,500 | R13,501+ |
| Principal Member | R439 | R 905 | R 1,151 | R 1,602 | R 2,269 |
| Spouse/Adult Dependant | R439 | R 905 | R 1,151 | R 1,602 | R 2,269 |
| Per Child | R396 | R 414 | R 430 | R 471 | R 668 |
| IN HOSPITAL BENEFIT | |||||
| 2020 BENEFITS | |||||
| 100% Scheme Rate | |||||
| No Overall Annual Limit | |||||
| *7 daysTake Home Medicine | |||||
| Annual Sub-limits per person: | |||||
| Psychiatric Treatment | PMB | ||||
| Hospice Care | n/a | ||||
| Oncology (at a State Hospital) | PMB | ||||
| CHRONIC MEDICATION | |||||
| 100% Scheme Rate | |||||
| 26 Chronic Disease Conditions. | |||||
| Subject to scheme formulary. | |||||
| Ingwe Primary Care Network. | |||||
| ANNUAL DAY TO DAY BENEFIT | |||||
| (including Savings) | |||||
| 100% Scheme Rate | |||||
| Primary Care Network. | |||||
| GP's | No Limit from Ingwe Primary Care Network. | ||||
| Pre-authorisation required from 11th visit. | |||||
| 1 out-of-network visit per person and max 2 visits | |||||
| per family per year with a R100 co-payment. | |||||
| Specialists: | 2 visits per family per year limited to R1 050 per person | ||||
| and R2 100 per family. | |||||
| Must be referred by a Network GP | |||||
| Conservative Dentistry: | No limit from Network Providers. | ||||
| Pre-authorisation required if more than 4 fillings | |||||
| or extractions. | |||||
| ANNUAL THRESHOLD | |||||
| Does not apply | |||||
As additional GP Network Plan comparisons are made available we will continue to update this page in our effort to provide our clients with the most up to date information and advice on the medical aid industry in South Africa. If you are still deciding which plan type is best suited to your situation, why not take a look at the Medical Aid Plans page to see the full range of plans.
For more detailed information on any of the above GP Network Plan comparisons simply contact us. If you already know what you want, why not make use of our site to download the relevant Medical Aid Application form and then fax it back to us on 0866 200 320 . Alternatively, if you would like us to confirm some of the finer details and pricing just fill in our free Medical Aid Quote Request form and we will get back to you promptly.
Finally, we invite you to contact us on +27 21 712 8866 at any point in your decision making process for further information on these GP Network Plan comparisons.
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